Abstract 14027: Long-Term Treatment With Sitagliptin Provides Multiple Antiatherosclerotic Effects Independent of Diabetic Improvement for Type-2 Diabetics With Stable Coronary Artery Disease
Introduction: Diabetes mellitus (DM) is thought to be highly involved in complex atherothrombogenic processes, but the long-term antiatherosclerotic therapies in patients with type-2 DM have not been established.
Hypothesis: Therefore we assessed hypothesis long-term treatment with sitagliptin, a dipeptidyl peptidase-4 inhibitor recently developed antidiabetic agent, chronically inhibits atherosclerotic progression in patients with type-2 DM.
Methods: Thirty-two type-2 diabetic patients with stable coronary artery disease were randomized to group-S where they received sitagliptin (50mg/day), or to group-C where they received enhanced antidiabetic therapy without a dipeptidyl peptidase-4 inhibitor for 2 years. We quantified flow-mediated endothelium-dependent dilation of right brachial artery after 5 minutes forearm occlusion (FMD), and intima-media thickness of common carotid artery (IMT) using high-resolution ultrasonography. We also quantified brachial-to-ankle pulse wave velocity (PWV). Changes in FMD, IMT, PWV, and practical metabolic variables were compared between the two study groups.
Results: The patients in group-S (n=16) manifested good compliance to the long-term treatment and improvements in diabetic and lipid variables represented by HbA1c and LDL after long-term medication of sitagliptin, while there were no improvements in group-C. FMD improved after medication in group-S (from 3.9±1.8% to 6.4±2.6%, p<0.01) but remained unchanged in group-C (from 4.1±2.0% to 3.9±1.9%, p=0.38). IMT did not increase in group-S (from 1.10±0.35mm to 1.08±0.39mm, p=0.16) but increased in group-C (from 1.09±0.46mm to 1.16±0.49mm, p<0.01). PWV (cm/s) decreased in group-S (from 1793±232cm/s to 1723±214cm/s, p=0.04), but increased in group-C (from 1754±273cm/s to 1835±232cm/s, p=0.03). Changes of FMD or PWV in group-S did not correlate to those of HbA1c (FMD: r=0.17, p=0.79, PWV: r=0.16, p=0.68).
Conclusions: This study suggests that long-term treatment of sitagliptin safely improves arterial function independent of reversal for diabetic status and reduces progression of wall thickness, which may have potential benefit for long-term management of atherosclerosis in type-2 diabetics with stable coronary artery disease.
Author Disclosures: T. Murakami: None. I. Moriuchi: None.
- © 2014 by American Heart Association, Inc.